Learning Objectives
Upon completion of this lecture, students will be able to: 1. Define
the principles of beneficence and
nonmaleficence. 2. Describe the nurse’s primary
commitment according to the professional code of ethics. 3. Identify
potential ethical conflicts between the duty to benefit the patient and
the duty to avoid harm. 4. Analyze how the welfare of others (society,
institutions, and the profession) competes with the nurse’s duty to the
individual patient.
Key Terminology
- Beneficence: The ethical principle of acting to
help others and promoting their welfare.
- Nonmaleficence: The ethical principle of “doing no
harm.”
- Primum non nocere: “First of all, do no harm”—a
slogan often associated with medical ethics priority.
- Act Consequentialism: Evaluating each individual
action based on its specific consequences.
- Rule Consequentialism: Following a set of rules
that, if generally followed, would produce the best consequences
overall.
- Role-specific Duty: Duties that belong to a person
because of their professional role (e.g., the nurse as a patient
advocate).
I. Introduction to Consequentialist Ethics
Ethical systems based on the outcomes of actions are known as
consequentialist theories. In nursing, this is
primarily expressed through two concepts: 1. Producing
Good: Striving to improve the patient’s health and well-being.
2. Avoiding Harm: Preventing injury, complications, or
suffering.
Historical Context
- Hippocratic Oath: Pledges to work for the “benefit
of the sick” and keep them from “harm and injustice.”
- Florence Nightingale Pledge: Includes the promise
to “abstain from whatever is deleterious and mischievous.”
- ANA Code of Ethics: States the nurse’s “primary
commitment is to the health, well-being, and safety of the
patient.”
II. Benefiting the Patient: Core Challenges
1. Uncertainty of Benefit
Nurses are often responsible for implementing plans where the benefit
is unclear or the harm is potential. * Critical
Inquiry: Nurses must question interventions they suspect are
not beneficial (e.g., the medicalization of natural processes like
dying). * Example Case (4-1): The “Ashley Treatment”
(shortening/sterilizing a child with severe developmental delays)
highlights the debate over what truly improves “quality of life.”
2. Health Benefits vs. Overall Well-being
A central tension exists between maximizing medical health
and maximizing overall well-being. * The
Problem: Is a nurse responsible for a patient’s social,
economic, or psychological well-being? * Case 4-2: A
patient who refuses to be clean or change a “dirty” environment. Does
the nurse’s duty to “health” override the patient’s “overall well-being”
as they define it?
3. Benefiting vs. Avoiding Harm (Primum non nocere)
Is it worse to hurt someone than it is to fail to help them? *
The Stringency of Harm: Many argue that the duty to
avoid harm is more stringent. * Conservative Care: If
nonmaleficence is the only priority, care becomes very conservative
(doing nothing ensures no active harm). * Clinical
Example: Working while sick (Case 4-4). Does the benefit of
providing one-on-one care outweigh the risk of infecting the
patient?
III. Act vs. Rule Consequentialism
How should a nurse decide the best course of action?
- Act Consequentialism: Calculate the net
benefits/harms for every specific situation. (Highly flexible but prone
to human error).
- Rule Consequentialism: Follow general rules (e.g.,
“Always turn patients every 2 hours”) because these rules generally
produce the best results, even if they seem incorrect in a specific
moment (Case 4-5).
- Analogy: Traffic lights. It is safer to always stop at red,
even if the road looks clear, because humans are fallible.
IV. Expanding the Circle: Benefiting Others
While the nurse’s primary duty is the patient, other parties often
have a claim on the nurse’s attention and resources.
1. Benefit to the Institution
- Cost Containment: Hospitals face financial
jeopardy. Nurses are often asked to act as agents of the institution
(e.g., limiting supplies for indigent patients, Case 4-6).
- The Conflict: Does the nurse remain a
patient advocate or become a cost-containment
agent?
2. Benefit to Society
- Allocation of Scarce Resources: When funds or
treatments are limited, should they go to the person who needs them most
(Justice) or the person who will benefit the most (Utility)?
- Example Case (4-7): Funding a bone marrow
transplant for one child vs. funding immunizations for thousands.
3. Benefit to the Profession
- Collective Action: Nurses have a duty to “maintain
and elevate the standards of the profession.”
- Strikes (Case 4-10): Does a strike to improve
future nursing care justify the temporary decrease in care for current
patients?
4. Benefit to Oneself and Family
- Self-Care: The nurse also has duties to self and
family.
- Pandemics (Case 4-11): In situations like an H1N1
outbreak, how does the duty to treat patients balance against the risk
to the nurse’s own children or personal health?
Discussion Questions for Students
- Who should define “well-being”—the nurse, the physician, or the
patient?
- If you were the nurse in Case 4-5, would you turn a terminal patient
who begs to be left alone because “the rule” says you must?
- Is it ever ethical for a nurse to prioritize their own family over
their duty to report to work during a disaster? ```